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Lighting a Beacon for Privatisation?

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People who care about Oxfordshire's mental health services may have noticed that our Primary Care Trust (soon to be replaced by a Clinical Commissioning Group) recently bought in private sector consultants to help them develop their commissioning strategy for Oxfordshire. One of these was Beacon UK – recently branded beaconhs.co.uk on their web site. While they do provide consultancy, they also act “... as an integrator, coordinating mental health services from different health and social care providers to ensure care effectively meets the needs of each person with mental health problems.” Sounds good, but what does it really mean?

 

On coming into power, the Conservative/Lib. Dem. Government removed the privileged status of NHS bodies as 'preferred providers' of NHS services, stating instead that any qualified provider could provide them. Since the early 1990s the NHS has been progressively split into 2 functions:

  • A commissioning function (which pays for services from money raised through taxation) and

  • A provider function (which delivers treatments).

What 'any qualified provider' means is that the second function – the bit that does the work - can be provided by any organisation that can meet the required quality standards, including private providers.

 

 

Hinchingbrooke Hospital in Cambridgeshire is now run as a 'partnership' between the NHS and private investment company Circle Holdings. http://www.bbc.co.uk/news/uk-england-cambridgeshire-16812998

 

In other words, they can use the NHS in their logo, put NHS on their web site, but still take a profit from delivering a service which was based on the idea of 'from each according to his means, to each according to his needs.' Last year's battle over the Health and Social Care Act 2012 was largely about this type of creeping privatisation, which many claim is being deliberately hidden from the public.

 

Beacon UK recently helped Oxfordshire CCG to organise a 'stakeholder event' on mental health commissioning. The focus of the event seems to have been to showcase the latest big 'new' idea – 'outcomes-based commissioning'. First up was Prof. Paul Corrigan, a very public advocate for NHS privatisation. Paul explained to the humble people of Oxfordshire that “The aim of this work is for OCCG to have a single contract for whole pathways” - putting all their service eggs in one basket. This wouldn't necessarily mean that one organisation did everything, but suggests that we might need a single organisation to act “...as an integrator, coordinating mental health services from different health and social care providers to ensure care effectively meets the needs of each person with mental health problems.” This organisation would then sub-contract the actual work – effectively becoming a commissioner itself, but probably without the safeguards designed to protect public accountability, employee rights and prevent conflicts of interest. Effectively, it would mean sub-contracting the whole commissioning function to a private provider.

 

Another keynote speaker at the event was Dr. Nick Hicks of the Nuffield Trust. According to his biography, Nick was once a Fellow of the ultra-right wing RAND Corporation. Nick explained how outcomes-based commissioning had led to savings of 25% in Milton Keynes. Beacon UK's Chief Executive, Dr. Emma Stanton, helped people to understand by offering a 'worked example'. According to this summary of the event, Emma promised that Outcome-based Commissioning' would ensure that “Patients will benefit from improved outcomes, less time in hospital, better integration of care, better information etc.” Emma is a Senior Associate of the Harvard Business School Institute for Strategy and Competitiveness, which developed the idea of outcomes-based commissioning. All 3 speakers felt able to talk on behalf of the CCG and what it is trying to do – even though the CCG is supposed to consist of local GPs working on behalf of local people.

 

The idea of 'outcomes-based commissioning' is simple in essence, but possibly far-reaching in its consequences. People who are interested in the detail can watch this video clip, in which American originators Michael E. Porter and the venerable Robert S. Kaplan explain their eureka moment. All I will say here is that the idea has clearly originated in the American context (where academics are struggling to make sense of a nonsensical market-based system of private health insurance), not in a UK context, where we have a rational, accountable healthcare system that is regularly ranked as one of the best value in the world.

 

From my point of view, there are two key points here. Firstly, the people brought in to advise the people who will shortly be running Oxfordshire's NHS seem to be pro-market ideologues with a strong bias towards the private sector in general and the United States in particular. The second is that one of these people – Dr. Stanton – is also Chief Executive of a company claiming to specialise in delivering exactly the kind of service structure they have recommended. It sounds very much like the CCG – which is supposed to represent local people – has chosen privatisation before it even formally exists!

 

Last week saw campaign group 38 Degrees force an important climb-down on new NHS regulations that would have forced Clinical Commissioning Groups to tender contracts – even where this made no sense for patients – clearly contradicting assurances given by Health Minister Earl Howe. It is clear that many groups and interests are already in the pockets of the private sector, which stands to make billions from NHS contracts. But it is also clear that a community of citizens, clinicians and academics are increasingly finding a voice and successfully taking action to halt privatisation. In just over 2 weeks a new body will take over the NHS in Oxfordshire. We need to make sure it doesn't sell out the NHS from under our feet.

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